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Pharmacy Refusals: State Laws, Regulations, and Policies

Fewer than half of the states in the country explicitly address the issue of refusals to provide medication to patients in the pharmacy. Eight states require pharmacists or pharmacies to ensure  that patients receive their medication. Seven states allow refusals but prohibit pharmacists from obstructing patient access to medication. Only six states permit refusals without critical protections for patients, such as requirements to refer or transfer prescriptions.

Pharmacy Policy Map August 2010

Below is a description of the state policies governing pharmacy refusals. Some states have enacted statutes or regulations governing the matter that have the force of law. In other states, pharmacy boards have issued interpretations of their laws and regulations, which do not have the force of law but provide guidance about the standard of practice, and can inform disciplinary proceedings.

States with a Policy Requiring Pharmacies or Pharmacists to Provide Medications

State Policy Applies to... Obligation Affected Medications Authority
California Pharmacist and Pharmacy  Pharmacist: may refuse only with employer’s consent
Pharmacy: must ensure timely access
All drugs Cal. Bus. & Prof. Code § 733 (2009)
 Illinois  Pharmacy  Must dispense  All drugs Ill. Admin. Code tit. 68,  § 1330.500 (2010) (enjoined as to two pharmacists and the pharmacies they own in Morr-Fitz, Inc. v. Blagojevich, No. 2005-CH-000495 (Ill. Cir. Ct. 7th Jud. Cir. 04/05/11)).
 Maine  Pharmacist  Must dispense  All drugs 02-392 Me. Code R. ch. 19 § 11 (Weil 2009) (citing Me. Rev. Stat. Ann. tit. 32 § 13795(2) (2009))
 Massachusetts  Pharmacist  Must dispense  All drugs Pharmacy board interpretation (2004) of Mass. Gen. Laws ch. 94C, § 19(a) (2009)
 Nevada  Pharmacist  Must dispense  All drugs  Nev. Admin. Code § 639.753 (2008)
 New Jersey  Pharmacy  Must dispense  All drugs  N.J. Stat. Ann. § 45:14-67.1 (West 2009)
 Washington  Pharmacy  Must dispense  All drugs  Wash. Admin. Code § 246-869-010 (2009) (enjoined as to two pharmacists and a pharmacy, in Stormans, Inc. v. Selecky, No. C07-5374RBL, 2012 WL 600702 (W.D. Wash. Feb. 22, 2012)).
 Wisconsin  Pharmacy  Must dispense  Contraception  Wis. Stat. Ann. § 450.095 (2009)

 

States with a Policy Prohibiting Obstruction or Refusals to Transfer/Refer

State Policy Applies to... Obligation Affected Medications Authority
Alabama Pharmacist Must provide meaningful referral/transfer  All drugs  Pharmacy board interpretation of professional obligations (2007)
Delaware Pharmacist and Pharmacy Pharmacist: no interference or abandoning patient Pharmacy: must accomodate pharmacist’s refusal while assuring delivery of services to patient  All drugs  Pharmacy board interpretation of professional obligations (2006); Del. Code Regs. 24 2500 § 3.1.2.4 (Weil 2009)
New York Pharmacist and Pharmacy Pharmacist: no interference or abandoning patient Pharmacy: must accomodate pharmacist's refusal while assuring delivery of services to patient  All drugs  Pharmacy board interpretation of professional obligations (2005)
North Carolina Pharmacist  No obstruction; must provide meaningful referral/transfer  All drugs  Pharmacy board interpretation of professional obligations (2005)
Oregon Pharmacist and Pharmacy  Pharmacist: notify employer; no obstruction; must provide meaningful referral/transfer Pharmacy: must accomodate pharmacist’s refusal while assuring delivery of services to patient  All drugs  Pharmacy board interpretation of professional obligations (2005)
Pennsylvania Pharmacist and Pharmacy  Pharmacist: no interference or abandoning patient  Pharmacy: must accomodate pharmacist’s refusal while assuring delivery of services to patient  All drugs  49 Pa. Code § 27.103 (2009) (statement of policy)
Texas Pharmacist  Must provide meaningful referral/transfer  All drugs  Pharmacy board interpretation of professional obligations (2006)

 

States with a Policy Permitting Refusals to Dispense without Patient Protections

State Policy Applies to... Obligation Affected Medications Authority
Arizona Pharmacy, hospital, or health professional, or any employee of a pharmacy, hospital or health professional Must return prescription to patient Emergency contraception or any drug or device intended to inhibit or prevent implantation of a fertilized ovum Ariz. Rev. Stat. Ann. § 36-2154(B) (2009)
Arkansas Pharmacists, physicians, employees, agents, and institutions None Contraception Ark. Code Ann. § 20-16-304(4) (2009)
Georgia Pharmacists None Any drug Ga. Comp. R. & Regs. r. 480-5-.03(n) (2009)
Idaho Health care professionals, licensed, certified, or registered by the state Must notify employer of refusal in advance; must provide treatment in life-threatening situations if no-one else is available Emergency contraception Idaho Code § 18-611 (2010) 
Mississippi All health care providers (including pharmacists) and institutions (including pharmacies) None Any drug Miss. Code Ann. § 41-107-1 to -13 (2009)
South Dakota Pharmacists None Any drug “believed” to cause abortion or death S.D. Codified Laws § 36-11-70 (2009)